Individual
KIRK GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, RN, PCCN
Contact information
Practice address
919 WILLOW DR, SHREVEPORT, LA 71118-4023
(318) 840-4843
Mailing address
919 WILLOW DR, SHREVEPORT, LA 71118-4023
(318) 840-4843
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN136488
LA
163WD0400X
Diabetes Educator Registered Nurse
Primary
RN136488
LA
Other
Enumeration date
07/23/2017
Last updated
07/21/2022
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